Mathew Paul G, Pavlovic Jelena M, Lettich Alyssa, Wells Rebecca E, Robertson Carrie E, Mullin Kathleen, Charleston Iv Larry, Dodick David W, Schwedt Todd J
Department of Neurology, Brigham and Women's Hospital, John R. Graham Headache Center, Boston, MA, USA; Cambridge Health Alliance, Division of Neurology, Harvard Medical School, Boston, MA, USA.
Headache. 2014 Apr;54(4):698-708. doi: 10.1111/head.12308. Epub 2014 Feb 11.
Optimizing patient satisfaction with their medical care and maximizing patient adherence with treatment plans requires an understanding of patient preferences regarding education and their role in decision making when treatments are prescribed.
To assess the congruence between patient expectations and actual practice regarding education and decision making at the time a triptan is prescribed.
This multicenter cross-sectional survey was performed by headache fellow members of the American Headache Society Headache Fellows Research Consortium at their respective tertiary care headache clinics. Migraine patients who were new patients to the headache clinic and who were current triptan users (use within prior 3 months and for ≥1 year) or past triptan users (no use within 6 months; prior use within 2 years) completed questionnaires that assessed the education they received and their role in decision making at the time a triptan was first prescribed as well as their desire for education and participation in decision making when a triptan is prescribed.
Consistent with patient preference, most participants received the majority of their education about the triptan from the prescriber's office (70.2%). In descending rank order, participants most desired to be informed about how to decide if a triptan should be taken, when during the course of migraine a triptan should be taken, possible side effects, cost, and how to obtain refills. Regarding side effects, most participants preferred to receive education about the most common side effects of a triptan rather than addressing all possible side effects. Regarding triptan dosing, participants desired to be informed in descending order of importance about taking other medications with triptans, how many doses can be taken for each migraine, how many doses can be taken each week/month, what to do if the triptan does not work, and the triptan mechanism of action. The vast majority of participants (92%) preferred that the decision to prescribe a triptan be a joint decision between the patient and the provider. In actual practice, participants were not as involved in decision making as they would like to be, with patients reporting that the prescriber was the sole decision maker 55.1% of the time. Participants had confidence in their providers (87.7%) and generally felt they did a good job educating them about the triptan (71.1%).
Based on this study, it is clear that patients prefer the shared model approach to medical decision making in regards to the prescription of triptans. The majority of patients received education that was generally consistent with their desires. Patients preferred that the prescribing provider be the primary source of information. The most desired educational topics included when/if a triptan should be taken, the number of times a triptan can be taken for a single migraine, co-administration with other acute medications, and the most common side effects. Focusing on these topics should enhance patient satisfaction and may improve compliance.
优化患者对医疗护理的满意度并使患者最大程度地遵守治疗计划，需要了解患者在教育方面的偏好以及他们在开出处方时参与决策的作用。
评估在开具曲坦类药物时患者在教育和决策方面的期望与实际做法之间的一致性。
这项多中心横断面调查由美国头痛协会头痛研究员研究联盟的头痛专科研究员在美国各自的三级头痛护理诊所进行。偏头痛患者为头痛诊所的新患者，且为当前曲坦类药物使用者（在过去3个月内使用且使用时间≥1年）或过去曲坦类药物使用者（在6个月内未使用；在2年内曾使用），他们完成了问卷，评估首次开具曲坦类药物时所接受的教育、他们在决策中的作用，以及开具曲坦类药物时对教育和参与决策的期望。
与患者偏好一致，大多数参与者从开处方医生办公室获得了关于曲坦类药物的大部分教育（70.2%）。按降序排列，参与者最希望了解如何决定是否应服用曲坦类药物、在偏头痛过程中的何时服用曲坦类药物、可能的副作用、费用以及如何获得续方。关于副作用，大多数参与者更喜欢了解曲坦类药物最常见的副作用，而非所有可能的副作用。关于曲坦类药物的剂量，参与者希望按重要性降序了解与其他药物联合使用曲坦类药物的情况、每次偏头痛可服用的剂量、每周/每月可服用的剂量、曲坦类药物无效时该怎么做以及曲坦类药物的作用机制。绝大多数参与者（92%）更希望开具曲坦类药物的决定是患者与医疗服务提供者共同做出的决定。在实际操作中，参与者在决策中的参与程度不如他们期望的那样，患者报告称开处方医生在55.1%的时间里是唯一的决策者。参与者对他们的医疗服务提供者有信心（87.7%），并且总体上感觉医疗服务提供者在向他们介绍曲坦类药物方面做得很好（71.1%）。
基于这项研究，很明显患者在曲坦类药物处方方面更喜欢共同决策的模式。大多数患者接受的教育总体上与他们的期望一致。患者更喜欢开处方的医疗服务提供者作为主要信息来源。最希望了解的教育主题包括何时/是否应服用曲坦类药物、单次偏头痛可服用曲坦类药物的次数、与其他急性药物的联合使用以及最常见的副作用。关注这些主题应能提高患者满意度并可能改善依从性。
